The 21st Century Cures Act – passed overwhelmingly by Congress in recent days – will have broad implications on health IT and medical technology.

The $6.3 billion bill is probably best known for:

Accelerating the path to FDA approval of drugs and medical devices by giving the Food and Drug Administration new authority in this area;

Providing $4.8 billion to the National Institutes of Health (subject to annual appropriations), including $1.8 billion for Vice President Joe Biden’s Cancer Moonshot initiative and funding for the president’s Precision Medicine and BRAIN initiatives;

Allocating $1 billion over two years to states to fight opioid abuse;

Being opposed by Sens. Elizabeth Warren, D-Mass., and Bernie Sanders, I-Vt., and a few other Democratic leaders, who denounced the bill as a handout to the drug industry. (The bill passed the Senate 94-5.)

Writing in The New York Times last month, Jennifer Steinhauer and Sabrina Tavernise described the legislation as addressing “problems that touch nearly every American life.”

Sets up a provider directory aimed to facilitate data exchange and favoring solutions to interoperability originating in the private sector;

Directs the Government Accountability Office to evaluate the current state of so-called “patient matching“ to their EHRs and determine steps the Department of Health and Human Services (HHS) can take to link patients to their records and avoid duplication.

Authorizes the HHS Office of the Inspector General to investigate and penalize data blocking offenses;

Broadens the Office of the National Coordinator on Health IT (ONC)’s authority over health IT certification, and combines the ONC’s Health IT Policy and Standards Advisory Committees.

Thinking about the impact of the Cures bill only in the context of EHRs misses the bigger picture, however. Funding for BRAIN, Precision Medicine and the Cancer Moonshot initiatives will accelerate scientists’ creation and use of large patient data sets and open up those data sets to researchers to advance research development.

“We should think of technology as neither revolutionary or remarkable unless it helps everyone,“ said D.J. Patel, chief U.S. data scientist with the White House, speaking at the Health 2.0 conference this fall about the importance of open data for these three big initiatives that received funding via the Cures bill. You can hear Patel talk about data and the Cures bill on NPR’s Science Friday on Dec. 9.

Oral health may be essential to overall health but the enduring gap between dental care and medical care impacts everything from how care is accessed to how services are financed, from how providers are educated to how research is pursued.

For millions of Americans, dental care is harder to find and pay for than medical care. Physicians and dentists operate in separate systems and oral and medical services are rarely integrated.

The dental-medical divide is not only formidable it “has significant consequences for patients and is entirely of our own making,” noted Health Affairs editor-in-chief Alan R. Weil in an introduction to the journal’s December issue.

“Like so many health care challenges, naming it is a useful first step, but much more is required to generate change on the scale that is needed,” Weil observed.

At a Dec. 7 briefing in Washington, D.C., contributors to the new issue offered insights. Insurance reform, workforce and safety net expansion, interprofessional training, the strengthening of access under Medicaid and the inclusion of dental benefits under Medicare could all potentially help to bridge the divide, they suggested in comments and in papers included in the journal.

“Dental care is an outlier compared to all other health care services,” said Marko Vujicic, chief economist at the American Dental Association’s Health Policy Institute. Dental benefits are bought and sold separately from health insurance and roughly one third of Americans lack them. Cost remains a major barrier to dental care, said Vujicic who called for “fundamentally re-designing” dental coverage.

For the uninsured and underinsured, dental care can be harder to find than medical care. Oral health services can also be harder to find in rural and poor communities. Many safety net clinics that offer medical care in these places still lack dental providers. Technically-trained dental therapists could help answer the need, said Jane Koppelman, research director for the Pew Charitable Trusts’ dental campaign.

“In medical-dental integration, when that is done on the grassroots level, we think of locating dental providers in medical offices,” she said.

Margaret Langelier, executive director of the State University of New York’s Oral Health Workforce Research Center said dental hygienists who are permitted a wide scope of practice could also help bridge the gap between dental and medical care.

“Placing dental hygienists in public health settings may have a long-term impact,” Langelier said.

While progress has been made, thanks to measures including water fluoridation and prevention efforts, tooth decay remains the most common chronic disease of childhood, other speakers noted .

Dental utilization rates among child Medicaid beneficiaries have improved in recent years, but child beneficiaries still suffer worse oral health than privately insured children, said Columbia University researcher Jaffer Shariff. “The dental care delivery system might not be sufficient,” he noted.

There are other problems as well. Physicians and dentists learn in separate schools and keep separate records. Dental benefits have not been fully incorporated into the nation’s health care reform law and their purchase is not mandated. Medicaid dental benefits are not guaranteed to poor adults and vary from state to state. Medicare does not currently cover routine dental benefits for more than 50 million elderly and disabled Americans.

Since sweeping the November elections, Republican promises to dismantle the Affordable Care Act (ACA) and re-engineer Medicare and Medicaid have worried many defenders of the programs.

Yet perhaps, amid the changes that the future holds, there will be opportunities to bridge the enduring dental-medical divide in systems and institutions, said University of Maryland School of Dentistry Professor Richard Manski.

He urged oral health advocates to think creatively and optimistically.

“How do we begin a new conversation?” he asked. “How do we advocate for the things we want – more integrated teaching? More integrated care?”

Can technology save us? It’s among several questions on a lot of people’s minds these days. Can technology save us from rising health costs? Can technology save Medicare by reducing costs to the program? Can technology help our veterans gain better access to care? Can technology help people take control of their health decisions?

At the same time, criticism of technology has grown in the aftermath of a presidential election that shocked many. There’s criticism about the proliferation of fake news on Facebook and other social media. And fears about Russia meddling in the election and potential hacking of voting systems all have put a focus on technology.

Amid this uncertainty, I attended a meeting of the American Medical Group Association in San Francisco last month and heard a rousing defense of technology from one of the country’s leading physicians. Robert Pearl, M.D., executive director and CEO of the Permanente Medical Group, gave an hour-long keynote address using no notes and no slides.

Pearl, who leads the medical group arm of Oakland, Calif.-based Kaiser Permanente, made the case that technology will be one of four pillars of health care in the 21st century. (The other three are physician leadership; integration of health care organizations and prepayment, a replacement for fee-for-service).

I think Pearl’s comments about technology are useful for reporters looking at the role technology will play in our health system moving forward.

“I believe very strongly it (technology) will be the solution,” Pearl told 600 AMGA members, most of them physicians. He urged them to embrace three technologies in particular:

Predictive data analytics: These are software programs that use an algorithm to predict risk among patients (such as risk for sepsis, central line infections and future emergency department visits). Hospitals around the country are implementing predictive analytic software at a quick pace. They have the potential to make care more efficient and tailored to patients and improve outcomes, Pearl said.

EHRs as a communication tool: Today, EHRs are primarily a repository of patient data that has yet to be sufficiently harnessed. Pearl predicted that EHRs would become a valuable tool for early diagnosis of disease and to engage in better preventative care. The data in an EHR that is wide-reaching because it includes demographics, geography, community, family history and ethnicity. If providers use this data wisely, they can calculate the risk of certain diseases, and run tests on patients who are high-risk to improve early detection, Pearl said.

“The question we should ask about technology to evaluate its use is “what problem is it trying to solve?” Pearl said. That’s a good guideline for journalists as well. Here are some questions to ask in your reporting:

How big is the problem in the first place?

What problem is this technology trying to solve?

How will it solve it?

One hot tech sector that Pearl predicted would fizzle is wearables. He argued that wearables offer no tangible solution to health care’s problems today. He called wearables “the inline skates of 25 years ago.”

“Wearables solve a very important problem,” Pearl joked. “It’s called Christmas and Hanukkah.”

Amid promises to overturn the health care reform law and re-engineer Medicaid, voters swept Republicans into power in November. Oral health advocates now are wondering what lies ahead for efforts to expand access to dental services to poor, working and uninsured Americans.

Dental benefits were not exactly a high-profile topic in the campaign. More than 100 million Americans, including seniors, working-age adults and children still lack dental coverage according to the National Association of Dental Plans.

But dental care advocates can claim some gains during the administration of President Barack Obama.

Children’s dental services are among the essential health care benefits in the Patient Protection and Affordable Care Act (ACA). Adult benefits, though not required by the law, have been for sale on state exchanges. Medicaid expansion under the health care reform law brought an entitlement of dental care to millions of new children and offered benefits to poor adults in some states. The Children’s Health Insurance Program (CHIP), the Clinton-era program which covers eight million children in working-poor families, was reauthorized by President Obama, who added to the law a guarantee of dental care.

Now the ACA is under heavy fire and funding for CHIP runs out next year. Medicaid’s future also seems uncertain.

Colin Reusch

Defending the dental provisions of the programs will be a top priority in the months to come, Children’s Dental Health Project policy analyst Colin Reusch blogged on DrBicuspid.com.

“We are rolling up our sleeves to preserve the progress we have made – both in expanding access to private dental coverage and moving toward a system that integrates oral health into medical coverage and the healthcare system at large,” Reusch wrote.

“President elect-Trump and some congressional leaders have discussed converting the Medicaid program into a block grant or instituting per-capita caps, structural changes that could pose a very real threat to the stability and robustness of coverage for children and families.”

President-elect Donald Trump signaled the direction in which he wants to take the Department of Health and Human Services with last week’s nomination of U.S. Rep. Tom Price (R-Ga.) to become the department’s secretary. Price, a physician, has earned a reputation as a fierce critic of the ACA who also supports a block grant approach to Medicaid.

Trump also selected Seema Verma to become administrator of the Centers for Medicare and Medicaid Services. A health care consultant, Verma is best known for designing Healthy Indiana Plan (HIP), Indiana’s Medicaid expansion model. The program has been hailed as a top accomplishment of the administration of Indiana Gov. Mike Pence, now vice president-elect.

In an August column in Health Affairs, Verma described the philosophy behind HIP and offered insights into its approach to providing dental benefits to the state’s poorest adults.

As a “consumer-driven” initiative, HIP is set up to familiarize members “with the concepts of commercial health insurance” as well as to encourage them to be “prudent consumers” she wrote.

Enrollees begin with HIP Plus coverage which offers “benefits similar to those found in the commercial health insurance and also includes modest dental and vision coverage,” she wrote.

To maintain their enrollment in HIP Plus, members are expected to make monthly contributions equal to 2 percent of their income. Those who fail to pay within the 60-day grace period are terminated from the program, Verma explained. Terminated HIP Plus members below the poverty line are transferred to the HIP Basic Plan, which offers a more limited benefit package that excludes dental and vision coverage.

Winners of the 2016 AAAS Kavli Science Journalism Awards included science journalist Christie Aschwanden of FiveThirtyEight, who received the Silver Award in the online category for a three-part series that every health journalist would do well to read, reread and bookmark.

The wording of questions in food questionnaire surveys used in nutrition research may not account for personal biases that participants unwittingly bring with them. “Although the questionnaire was meant simply to measure our food intake, at times it felt judgmental — did we take our milk full fat, low fat or fat free?” Aschwanden explains. “I noticed that when I was offered three choices of serving sizes, my inclination was to pick the middle one, regardless of what my actual portion might be.”

Christie Aschwanden

Questions about servings also become problematic if researchers do not take seasonal eating patterns into account. Aschwanden writes:

“Some questions — how often do you drink coffee? — were straightforward. Others confounded us. Take tomatoes. How often do I eat those in a six-month period? In September, when my garden is overflowing with them, I eat cherry tomatoes like a child devours candy. I might also eat two or three big purple Cherokees drizzled with balsamic and olive oil per day. But I can go November until July without eating a single fresh tomato. So how do I answer the question?”

She similarly describes the difficulty in prospective studies of tracking food, the challenge of too many variables and other limitations of nutrition studies, including the fact that “We expect far too much from them,” Aschwanden writes. “We want to answer questions like, what’s healthier, butter or margarine? Can eating blueberries keep my mind sharp? Will bacon give me colon cancer? But observational studies using memory-based measures of dietary intake are tools too crude to provide answers with this level of granularity.”

Aschwanden’s final piece in the series, “Failure Is Moving Science Forward,” explored the “reproducibility crisis” in science and why some real effects may not appear in studies that attempt to reproduce them. For health journalists in particular, this story is perhaps the most important of the three. Understanding replication and reproducibility are essential to providing context in stories about the latest study. In fact, her subsection “When studies conflict, which is right?” will be helpful to journalists frustrated with covering issues where the study findings seem to flip back and forth with each successive study.

“The thing to keep in mind is that no single study provides definitive evidence,” she wrote. “The more that science can bake this idea into the way that findings are presented and discussed, the better.” The more frequently that health journalists can communicate this reality to readers where appropriate, the more informed and respectful of the scientific method readers (hopefully) will become.

A year after the Flint water crisis made national waves, the legacy of lead continues to draw attention as reporters follow up on the evolving public health concern.

What was once a public battle over perception as manufacturers’ inundated products with lead – from gasoline to painted cribs, toys and houses – has shifted to a more subtle, but no less serious disaster, according to public health historians Gerald Markowitz and David Rosner.

Markowitz and Rosner, authors of “Lead Wars: The Politics of Science and the Fate of America’s Children,” recently told AHCJ members that while children with lead poisoning are no longer exhibiting dramatic seizures and other effects, continued poisoning from the ground and other sources still is a serious problem for an estimated half a million U.S. children.

Children may no longer be eating large chips of lead paint, but the contaminant still seeps in through air and soil. “Lead has become a problem not just in the pipes in Flint, but it’s now literally a problem countrywide, and also specifically in lead paint cases, which have been historically the biggest issue for children,” Rosner said during the Nov. 4 AHCJ webcast.

Companies had long understood the health problem of lead, but over the decades shifted blame rather than tackle the toxicity, he said. “We’re still suffering from it.”

Although lead most often is considered a problem in urban dwellings and areas, it affects rural areas as well, Rosner said. Across the United States, 23 million homes still contain lead, with young children living in 4 million of them.

For journalists researching lead stories in their community, gathering information can be tough since there is little national tracking and each locality up to its own devices, the two professors said. For example, part of the problem with pipes is just identifying which ones still contain lead, a project that some municipalities track but others do not. Markowitz and Rosner said they plan to present their repository of information online in coming weeks (stay tuned; we will update on healthjournalism.org)

Testing and care also are still a concern, they said. While there is no treatment, the cases with chronic exposure mean children need more access to special educational services that may or may not be available or consistent in some school districts. Better consistency in testing all children for exposure also is needed, Rosner said.

“In a certain sense, the history of lead poisoning in children is a great story of a public health victory,” Markowitz said. “We have gotten lead out of paint and out of gasoline. But it is also a public health failure because the lead that was put on the walls, the lead that was put into the gasoline continues to poison children in the United States today.”

“It really is unconscionable that 500,000 children today still have their life chances decreased and their ability to succeed thwarted.”

]]>0Len Bruzzesehttp://healthjournalism.orghttp://healthjournalism.org/blog/?p=294752016-12-02T17:03:41Z2016-12-02T15:01:43ZPlease welcome these new professional and student members to AHCJ. All new members are welcome to stop by this post’s comment section to introduce themselves.

If you haven’t joined yet, see what member benefits you’re missing out on: Access to more than 50 journals and databases, tip sheets and articles from your colleagues on how they’ve reported stories, conferences, workshops, online training, reporting guides and more. Join AHCJ today to get a wealth of support and tools to help you.

]]>0Pia Christensenhttp://healthjournalism.orghttp://healthjournalism.org/blog/?p=294672016-12-01T21:40:04Z2016-12-01T21:36:34ZThe public’s right to information was bolstered by a federal judge’s decision that the U.S. Department of Agriculture should release data about how much taxpayers pay to retailers through the Supplemental Nutrition Assistance Program (SNAP).

The decision was in response to a lawsuit filed by Argus Leader Media in South Dakota, which had filed a Freedom of Information Act request for the “annual sales amounts of every business in the nation that participates in SNAP. USDA refused to release the data, and the paper filed suit in 2011.”

The Association of Health Care Journalists, joined by several other journalism organizations, supported the effort in a letter to USDA Secretary Tom Vilsack in April 2013. An op-ed by Felice J. Freyer and Irene M. Wielawski, then co-chairs of AHCJ’s Right to Know Committee, was published in the Los Angeles Times in August 2013 calling for the release of the data.

“This ruling is a great victory for taxpayers’ right to know how their money is being spent,” said Felice J. Freyer, chair of AHCJ’s Right to Know Committee. “It’s also an example of why news outlets can and should push back — in court, if need be — when they are denied access to government information. Congratulations to the Argus Leader on its courage, commitment — and success.”

Food industry representatives argued that their businesses would suffer competitive harm from the release of revenue data but District Judge Karen Schreier disagreed. “SNAP sales are merely a part of the store’s total revenue,” she wrote. “SNAP data does not disclose a store’s profit margins, net income, or net worth. SNAP data also does not disclose how a company bids on government contracts or negotiates with the federal government.”

According to the Argus Leader, the USDA is reviewing the ruling and has 60 days to appeal to the Eighth Circuit Court of Appeals.

August 2013: The Los Angeles Times published an op-ed by the co-chairs of the Association of Health Care Journalists’ Right to Know Committee calling on Congress and the U.S. Department of Agriculture (USDA) to end the secrecy surrounding the multibillion-dollar food stamps program.

For low-income elders, dental care can be very hard to find. Medicare does not include routine dental benefits and seniors living on low or fixed incomes may lack the money to pay out of pocket for care.

Reporter Paul Sisson, who covers health care for the San Diego Union-Tribune paid a visit and provided readers with an engaging story that captured the spirit of the place and highlighted the deep needs it aims to serve. In this new Q and A, Sisson talks about his work on the dental clinic feature and shares some wisdom on how he stays on top of his busy health care beat.

President-elect Donald Trump has selected Dr. Tom Price, an orthopedic surgeon from Georgia who has served in the House for six terms, to serve as his secretary of Health and Human Services.

That’s a signal that the Trump administration is going to pursue a very conservative health policy agenda – and not just on repealing the Affordable Care Act.

Price is the author of one of several ACA replacement proposals put forth in the House – and it’s one of the most conservative. He relies heavily on market forces, and the tax code to reshape the post-ACA insurance market. People would get subsidies in the form of tax credits – based on age, not their economic status, and generally not enough to pay for the kind of comprehensive plans on the market today.

But he says people should have the option of buying narrower plans – and that competition and deregulation will bring down prices. He also expands Health Savings Accounts, limits the tax breaks for companies that cover their workers (and dependents) and creates high-risk pools (but only puts in about $3 billion over three years, which even other conservative analysts see as low).

Here’s an essay Price and two other conservative physicians serving in the House wrote this fall for JAMA Forum.

And here’s an op-ed from Price himself on the conservative Townhall site backing the plan Speaker Paul Ryan put forth for House Republicans. (Price’s own preferred approach is similar but somewhat to the right.)

As the GOP fights over whether and how much of the Affordable Care Act to preserve – and how strenuously to preserve it – while the country transitions to a “replacement,” the HHS secretary will have a key role. Price would have a say in deciding which rules get rolled back, which get vigorously enforced, and will shape how the exchanges function in the interim. It’s not clear, for instance, how the incoming administration will address the cost-sharing subsidies that the House GOP sued the Obama administration over. If they stop them, insurers are more likely to flee the exchanges and speed up the demise of the ACA. Even if Price’s HHS doesn’t do anything very drastic for a year or so, it’s hard to imagine him flying around the country a la Sylvia Burwell encouraging people to sign up next year.

But his agenda doesn’t stop with the ACA. He also wants to overhaul Medicaid and Medicare, putting a far more conservative stamp on them. He’d block grant Medicaid – and turn Medicare into a voucher-like premium support program. For procedural and political reasons – both will be harder for the incoming Congress than repealing the ACA.